MX2007003817A

MX2007003817A - Endoscopic ancillary attachment devices.

Info

Publication number: MX2007003817A
Application number: MX2007003817A
Authority: MX
Inventors: Frederick E Shelton Iv; Mark S Ortiz; Michael J Stokes
Original assignee: Johnson & Johnson
Priority date: 2006-03-30
Filing date: 2007-03-29
Publication date: 2008-12-01
Also published as: EP1839556B1; AU2007201265A1; BRPI0701992A; US7615004B2; JP2007268270A; BRPI0701992B8; CN101057775B; BRPI0701992B1; JP5349761B2; US20070232850A1; EP1839556A1; AU2007201265B2; CN101057775A; HK1108339A1; ATE459288T1; CA2582961C; CA2582961A1; DE602007005037D1

Abstract

Methods and devices are provided for attaching one or more ancillary devices to an endoscope. The ancillary device can be any device that is used in conjunction with endoscopic procedures, such as, by way of non-limiting example, an accessory channel, tube, or sleeve, an indwelling tube or feeding tube, and surgical tools such as graspers, snares, etc. The ancillary device(s) can be positioned adjacent to and along side an external surface of an insertion portion of an endoscope for inserting into a body lumen, and one or more attachment devices can be used to mate the ancillary device(s) to the endoscope at one or more attachment locations. In use, the attachment device(s) will allow the ancillary device to move in coordination with the endoscope, thus allowing the endoscope and the ancillary device(s) to be introduced and guided through a tortuous pathway. In certain exemplary embodiments, the attachment device(s) can be configured to prevent radial movement, i.e., twisting, of the ancillary device relative to the endoscope, yet allow axial sliding of the ancillary device relative to the endoscope.

Description

ENDOSCOPIC AUXILIARY FIXING DEVICES FIELD OF THE INVENTION The present invention relates to methods and devices for attaching one or more auxiliary devices to an endoscope.

BACKGROUND OF THE INVENTION Minimally invasive procedures are desirable since such procedures can reduce pain and provide relatively fast recovery times compared to conventional open medical procedures. Many of the minimally invasive procedures are performed with an endoscope (including without limitation laparoscopes). Such procedures allow a physician to place, manipulate and observe medical instruments and accessories within the patient through an opening with small access in the patient's body. Laparoscopy is a term used to describe this "endo-surgical" approach using an endoscope (often a rigid laparoscope). In this type of procedure, accessory devices are often inserted into a patient through trocars placed through the body wall.

Even less invasive treatments include those performed through the insertion of an endoscope in a translumenal way, that is, through a natural body orifice to a treatment site. Examples of such an approach include, but are not limited to, cystoscopy, hysteroscopy, esophagogastroduodenoscopy, and colonoscopy. Many of these procedures employ the use of a flexible endoscope during the procedure. Flexible endoscopes often have a flexible hinge section orientable near the distal end that can be controlled by the user when using controls at the proximal end. Some flexible endoscopes are relatively small (1 mm to 3 mm in diameters) and may not have an integral accessory channel (also called biopsy channels or work channels). Other flexible endoscopes, including gastroscopes and colonoscopes, have integral working channels that have a diameter of about 2.0 mm to 3.5 mm for the purpose of introducing and removing medical devices and other accessory devices to perform diagnostics or therapies within the patient. As a result, accessory devices used by a physician may be limited in size by the diameter of the accessory channel of the range used. Additionally, the physician can be limited to a single accessory device when using the standard endoscope that has a working channel. Certain specialized endoscopes are available, such as large working channel endoscopes having a working channel of 5 mm in diameter, which can be used to pass relatively large fittings, or to provide suction capacity for large blood clots. Other specialized endoscopes include those that have two working channels. A drawback of such multi-channel / large diameter endoscopes may be that such devices are relatively expensive. In addition, said multi-channel / large diameter endoscopes may have an outer diameter that makes the endoscope relatively rigid, or otherwise difficult to intubate. It is often desired to place an auxiliary device, such as a tool or a working channel for receiving a tool, along the external surface of the endoscope. Although several techniques are known to fix auxiliary devices to an endoscope, one drawback of current techniques is the potential for the auxiliary device to move as the endoscope is inserted through the tortuous path. This can affect the ability of the surgeon to control the device and to keep the device within a desired field of vision of the image capability of the endoscope. Also, there is a need for improved methods and devices for attaching one or more auxiliary devices to an endoscope.

BRIEF DESCRIPTION OF THE INVENTION The present invention provides methods and devices for attaching an auxiliary device, such as an accessory channel or a surgical tool, to an endoscope. In an exemplary embodiment, an auxiliary fixation device is provided and includes a clip having an axial path formed therethrough and configured to receive an endoscope and an auxiliary device. The axial path expands to allow the clip to expand to be positioned radially around an endoscope and an axially extending auxiliary device adjacent to the endoscope and allow the clip to close around the endoscope and the auxiliary device to engage and hold the auxiliary device in a substantially fixed position relative to the endoscope. Although the clip can have a variety of configurations, in one embodiment the clip can include a plurality of segments spaced axially from one another and defines the axial path extending therethrough. In certain exemplary embodiments, each segment may include a tool engaging portion adapted to be positioned radially about and to engage an arrow of an endoscope, and a tool set portion adapted to seat an auxiliary device thereon for securing the device. auxiliary to the endoscope. The tool engaging portion may be in the form of a ring-shaped member, and the tool seating portion may be in the form of a protrusion formed in the ring-shaped member and defining a groove for seating a portion of the ring. an auxiliary device. In use, the tool seating portion can maintain an auxiliary device in a fixed radial position relative to an endoscope. In another embodiment, each segment may include first and second terminal ends that overlap to form a circular member. At least one of the terminal ends of each segment may be coupled together. In other embodiments, the clip may be in the form of a coiled body having a plurality of successive turns, each twist of the body twisted into a segment. The clip may also include a variety of other features to facilitate the coupling of an auxiliary device to an endoscope. For example, the clip may include a liner placed on at least a portion of an inner surface of the clip to prevent misalignment between the clip and an endoscope and / or an auxiliary device extending therethrough. In another embodiment, an endoscopic device is provided and includes an endoscope having an elongated arrow with a viewing element located at a distal end thereof, an auxiliary device configured to be positioned axially adjacent to the endoscope, and at least one attachment device that it has a plurality of axially spaced expandable segments measured to be positioned radially around a portion of the endoscope and the auxiliary device for coupling the auxiliary device to the endoscope. The fixation device can be adapted to maintain the auxiliary device in a radially substantially fixed position relative to the endoscope, even allowing axial sliding of the auxiliary device relative to the endoscope. In an exemplary embodiment, the equipment includes a plurality of fixation devices for coupling an auxiliary device to an endoscope in a plurality of locations. A method for attaching an auxiliary device to an endoscope is also provided, and in one embodiment the method can include placing an auxiliary device axially adjacent an elongated insertion portion of an endoscope, and positioning at least one fixation device. radially expandable radially around the endoscope and the auxiliary device for attaching the auxiliary device to the endoscope so that the auxiliary device moves in coordination with the endoscope. The fixation device or devices can maintain the auxiliary device in a substantially fixed radial position relative to the endoscope, even allowing the axial sliding of the auxiliary device in relation to the endoscope. In an exemplary embodiment, a plurality of radially expandable fixation devices are placed radially around the endoscope and the auxiliary device at a plurality of locations along a length of the endoscope and the auxiliary device. Various techniques can be used to place the device or fixation devices around the endoscope and the auxiliary device, and the technique will vary depending on the configuration of the fixation device or devices. In one embodiment, the fixation device may have a coiled configuration that is placed around the endoscope and the auxiliary device by rotating the fixation device around the endoscope and the auxiliary device. In another embodiment, the attachment device may include a plurality of ring-shaped segments each having first and second terminal ends. The fixation device can be placed around the endoscope and the auxiliary device by separating the end systems of each segment to expand the fixation device, and placing the expanded fixation device around the endoscope and the auxiliary device. The terminal ends of each segment can be brought together to couple the endoscope and the auxiliary device. The fixation device or devices may also include other features, such as a groove formed in an inner surface thereof and adapted to seat the auxiliary device therein to maintain the auxiliary device in a radially fixed position relative to the endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS The invention will be understood in its entirety from the following detailed description taken in conjunction with the accompanying drawings, wherein: Figure 1A is a perspective view of one embodiment of an auxiliary fixation device for attaching an auxiliary device to an endoscope , Figure 1 B is a perspective view showing the device of Figure 1 A in use fixing an auxiliary device to an endoscope.

Figure 2A is a perspective view of another embodiment of an auxiliary fixation device for attaching an auxiliary device to an endoscope; Figure 2B is a perspective view showing the device of Figure 2A in use attaching an auxiliary device to an endoscope, Figure 3A is a perspective view of even another embodiment of an auxiliary fixation device for attaching an auxiliary device to an endoscope; Figure 3B is a perspective view showing the device of Figure 3A in use attaching an auxiliary device to an endoscope.

DETAILED DESCRIPTION OF THE INVENTION Certain exemplary embodiments will now be described to provide a complete understanding of the principles of structure, function, manufacture and use of the devices and methods described herein. One or more examples of these modalities are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with an exemplary embodiment may be combined with the characteristics of other embodiments. Said modifications and variations are intended to be included within the scope of the present invention. The present invention generally provides methods and devices for attaching one or more auxiliary devices to an endoscope. The auxiliary device can be any device that is used in conjunction with endoscopic procedures, such as, by way of a non-limiting example, an accessory channel, tube or sleeve, a drainage tube or a feeding tube, and surgical tools such as fasteners, clamps, etc. The auxiliary device or devices may be placed adjacent to and along an external surface of an insertion portion of an endoscope for insertion into a lumen of the body, and one or more fixation devices may be used to couple the auxiliary device or devices to the endoscope in one or more fixation locations. In use, the fixation device or devices will allow the auxiliary device to move in coordination with the endoscope, thus allowing the endoscope and the auxiliary device or devices to be introduced and guided through a tortuous path. In certain exemplary embodiments, the fixation device or devices may be configured to prevent radial movement, i.e., torsion, of the auxiliary device relative to the endoscope, or even allow axial sliding of the auxiliary device relative to the endoscope. One skilled in the art will appreciate that the term "endoscope" as used herein is intended to include any endoscopic or laparoscopic viewing device.

Figure 1A illustrates an exemplary embodiment of an auxiliary fixation device 10 for securing one or more auxiliary devices to an endoscope. In general, the fixing device 10 is in the form of an elongated body formed from a plurality of segments 10a, 10b, 10c, 10d, 10e which are separated from one another along an axis of the fixing device 10. segments 10a-e define a path 12 formed therethrough to receive an endoscope and one or more auxiliary devices therein. The shape of segments 10a-e, and in this way the shape of the trajectory 12 may vary depending on the configuration of the endoscope and the auxiliary device or devices. In the illustrated embodiment, each segment 10a-e is ring-shaped with the first and second terminal ends (terminal ends 14a, 14b are shown in segment 10a) that overlap to form the ring. In this way, each segment 10a-e has a substantially circular cross-sectional shape. The inner diameter D-? of the segments, and thus the path 12, may vary depending on the size of the endoscope and the auxiliary device or devices, as well as the desired strength of the coupling connection. For example, the path 12 may have an inner diameter 10a-e that is smaller than a maximum outer diameter of the endoscope and the auxiliary device, such as a frictional fit that is formed between the fixation device 10 and the endoscope and the device assistant. The friction adjustment can be configured to avoid any movement between the auxiliary device and the endoscope. As will be discussed below, other techniques may be used to facilitate coupling between the fixation device 10 and an endoscope and the auxiliary device or devices, and other types of adjustments may be used such as a slidable fit, which allows the auxiliary device to slide with relation to the endoscope. One skilled in the art will appreciate that segments 10a-e may have other shapes in cross section such as square, ovular, rectangular, triangular, etc. The segments 10a-e may also have an open configuration. For example, the terminal ends of each segment 10a-e can be separated to form a C-shaped member. One skilled in the art will appreciate that the fixation device 10 can include only one segment, so that the device is in the form of a member in the form of an individual ring. The particular amount of segments 10a-e may also vary depending on the desired portions of an auxiliary device to be attached to an endoscope, and the desired resistance of the coupling connection between the auxiliary device or devices and an endoscope. For example, the fixation device 10 may include numerous segments so that the device 10 has a length Li that is substantially equal to the length of an insertion portion of an endoscope, thereby enabling the auxiliary device 10 to be attached to the endoscope at along the entire length of it. Alternatively, the fixation device 10a-e may include few segments so that only a portion of the auxiliary device is attached to an endoscope. With such configuration, multiple fixation devices can be used and placed in various locations along the length of an endoscope and an auxiliary device, as will be discussed in greater detail below. The size of each segment 10a-e for example, the width, length, thickness, etc., may also vary to obtain a desired coupling connection between an auxiliary device or device and an endoscope. As noted above, the segments 10a-e can be axially separated from each other, ie, separated along the axis Ai. Said configuration allows the fixation device 10 to flex axially in coordination with the flexure of the endoscope and the auxiliary device as the devices are inserted through a tortuous path, as will be discussed in more detail below. Although various techniques can be used to couple the segments 10a-e and keep them in a separate axial relationship, Figure 1A illustrates a bar of the transverse connector 16 extending axially along the fixing device 10 and fixed to the first end of each segment 10a-e. The bar of the transverse connector 16 can also facilitate the coupling of the fixation device 10 around an endoscope and the auxiliary device or devices., as the bar of the transverse connector 16 can be engaged and pulled in an open configuration wherein the device 10 can be placed around the endoscope and auxiliary device or devices. Figure 1 B illustrates the fixation device 10 in use placed around the endoscope 20 and an auxiliary device 30 for coupling the auxiliary device 30 to the endoscope 20. Although various techniques can be used to position the fixation device 10 radially around the endoscope 20 and the auxiliary device 30, in an exemplary embodiment the fixing device 10 expands. In particular, the end ends of each segment 10a-e can be moved away from each other to form an axial opening in the fixing device 10. This can be achieved by merely grasping and pulling the transverse connector bar 16 away from the device 10 to form an aperture. between the first and second terminal ends of each segment 10a-e. The fixation device 10 can then be positioned radially around the endoscope 20 and the auxiliary device 30 and the end ends can move together to cause the fixation device 10 to engage the endoscope 20 and the auxiliary device 30 therein. Although each segment 10a-e may include a hinge or other joint formed therein to allow the ends to move relative to each other, in an exemplary embodiment the terminal ends are biased to a closed configuration, as shown in the figures. 1A and 1B. This can be achieved by forming the fastening device 10, or at least the segments 10a-e of the fastening device 10, of a flexible material, such as a plastic or metal. One skilled in the art will observe that a material can be selected to produce a fastening device 10 having a desired amount of strength and flexibility. Figure 2A illustrates another embodiment of a fixation device 100 for removably attaching one or more auxiliary devices to an endoscope. In this embodiment, the fastening device 100 has a coiled configuration with each successive rotation forming a segment 100a-d of the coil. The wound fastening device 100 also includes first and second terminal ends 114a, 114b formed at opposite ends thereof. As noted above, the number of turns or segments, as well as the amount of separation between the segments, can be varied to obtain a desired amount of flexibility. In an exemplary embodiment, the device 100 has a flexibility that allows a path 112 to extend through the device to expand and receive an endoscope and one or more auxiliary devices there, and an inner diameter D2 that allows the device 100 to engage and maintain the auxiliary device (s)) in close contact with the endoscope, and more preferably in a radially substantially fixed position relative to the endoscope. Figure 2B illustrates the device 100 in use disposed around an endoscope 120 and an auxiliary device 130. To attach the fixation device 100 to the endoscope 120 and the auxiliary device 130, the first terminal end 114a of the fixation device 100 can be placed around of the endoscope 120 and the auxiliary device 130. The fixation device 100 can then rotate to rotatably place the fixation device 100 around the endoscope 120 and auxiliary device 130, thereby coupling the auxiliary device 130 to the endoscope 120. In an exemplary embodiment, the diameter D2 of the path 112 is smaller than a maximum diameter of the endoscope 120 and the auxiliary device 130, such that the fixation device 100 expands slightly when it is arranged around the endoscope 120 and the auxiliary device 130 to form a coupling connection narrow, such as a friction fit or slip adjustment, between the os devices. As previously explained with respect to Figures 1A and 1B, various materials can be used to form an expandable fixation device. In other embodiments, the fixation device may include features to assist in preventing radial movement, i.e., rotation, of the auxiliary device around the outer perimeter of the endoscope. As a non-restrictive example, the fixation device can be formed from a non-slip material that is effective to hold the endoscope and the auxiliary device. In another embodiment, a portion of the fixation device, such as the interior surface of the device, may include a non-slip surface coating disposed thereon, or may include other surface features, such as gripping teeth or protuberances, that attach the endoscope and the device. assistant. The coupling or coating features can also be arranged or formed only in portions of the fixation device to allow the device to be coupled to the endoscope, but allow a free sliding movement of an auxiliary device. Figure 3A illustrates another embodiment of a technique to prevent radial movement between an endoscope and an auxiliary device. As shown, the fixing device 200 is similar to the device 100 of Figure 2A, and has a configuration wound with successive turns, each of which forms a segment 200a-e. In this embodiment, however, each segment 200a-e includes a stop 202a-e or projection formed therein that defines a slot 204a-e on an interior surface of segment 200a-e for seating an auxiliary device. The slots 204a-e of the segments 200a-e are axially aligned, such that the auxiliary tool can extend axially through the path 212 and can settle within each of the slots 204a-e. In use, as shown in Figure 3B, the slots 204a-e will be coupled to the auxiliary device 230 and will prevent radial movement of the device 230 relative to the endoscope 220. Thus, the auxiliary device 230 will remain in a substantially fixed radial position. around the endoscope 220. One skilled in the art will appreciate that a variety of techniques can be used to substantially prevent movement between the fixation device, the endoscope and the auxiliary device (s). Although FIGS. 1 B, 2B and 3B illustrate a single fixation device arranged around a distal portion of an endoscope and auxiliary device, the various fixation devices described herein may be arranged around any portion of an endoscope and one or more other devices. auxiliaries for coupling to the auxiliary device (s) to the endoscope at desired coupling locations. For example, a device containing multiple fixation devices may be provided and may be positioned at a distance apart from one another at various locations along a length of an endoscope and an auxiliary device, thereby forming several attachment points. Depending on the configuration of each fastening device, the fastening device (s) can prevent radial movement, ie, rotation, of the auxiliary device (s) while allowing ( n) the axial movement, ie sliding, of the auxiliary device (s) in relation to the endoscope. As a result, the fixation device (s) can (n) allow the auxiliary device (s) to move in coordination with the endoscope as it is guided through a sinuous path. One skilled in the art will observe additional features and advantages of the invention based on the embodiments described above. Accordingly, the invention is not limited by what has been shown and described in particular, except as indicated in the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.

Claims

NOVELTY OF THE INVENTION CLAIMS

1. - An auxiliary fixing device, comprising: a clip having an axial path formed through it configured to receive an scope and an auxiliary device, the axial path being expandable to allow the clip to expand to position radially around an scope and an auxiliary device extng axially adjacent the scope, and to allow the clip to close around the scope and the auxiliary device to engage and hold the auxiliary device in a substantially fixed position relative to the scope, the clip including a plurality of segments axially spaced from one another and defining the axial path extng through it.

2. - The device according to claim 1, further characterized in that the clip has a substantially circular cross-sectional shape.

3. The device according to claim 1, further characterized in that each segment includes a tool coupling portion adapted to be arranged radially about and engage an arrow of an scope, and a tool set portion adapted to seat a device. auxiliary there to join the auxiliary device to the scope.

4. The device according to claim 3, further characterized in that the tool coupling portion comprises a ring-shaped member, and the tool seating portion comprises a protrusion formed in the ring-shaped member and defining a slot for seating a portion of the auxiliary device.

5. The device according to claim 3, further characterized in that the tool seating portion is adapted to maintain an auxiliary device in a fixed radial position relative to an scope.

6. - The device according to claim 1, further characterized in that each segment includes first and second terminal that overlap to form a circular member, at least one of the terminal of each segment being coupled with each other.

7. - The device according to claim 1, further characterized in that the clip comprises a coiled body having the plurality of successive turns, each turn of the wound body comprising a segment.

8. - The device according to claim 1, further characterized in that it also comprises a coating arranged on at least a portion of an internal surface of the clip to prevent sliding between the clip and an scope and / or auxiliary device that is ext through it.

9. - An scopic equipment, comprising: an scope having an elongated arrow with a viewing element located at a distal thereof; an auxiliary device configured to position axially adjacent the scope; and at least one attachment device having a plurality of axially spaced expandable segments spaced to be disposed radially around a portion of the scope and the auxiliary device for coupling the auxiliary device to the scope.

10. The equipment according to claim 9, further characterized in that the at least one fixation device is adapted to maintain the auxiliary device in a radial position substantially fixed in relation to the scope, but which simultaneously allows the axial sliding of the auxiliary device in relation to the scope.

11. The equipment according to claim 9, further characterized in that the equipment includes a plurality of fixation devices for coupling an auxiliary device to an scope in a plurality of locations.

12. - The equipment according to claim 9, further characterized in that each segment includes a tool coupling portion adapted to be arranged about and coupled to an arrow of the endoscope, and a tool seating portion adapted to seat the auxiliary device there for coupling the auxiliary device to the endoscope.

13. - The equipment according to claim 12, further characterized in that the tool coupling portion comprises a ring-shaped member, and the tool seating portion comprises a projection formed on the ring-shaped member and defining a slot for seating a portion of the auxiliary device.

14. - The equipment according to claim 9, further characterized in that each segment includes first and second terminal ends that overlap to form a circular member, at least one of the ends of each segment being coupled to each other.

15. - The equipment according to claim 9, further characterized in that the clip comprises a coiled body having a plurality of successive turns, each turn of the coiled body comprises a segment.

16. - A method for attaching an auxiliary device to an endoscope, comprising: placing an auxiliary device axially adjacent to an elongated insertion portion of an endoscope; and positioning at least one radially expandable fixation device around the endoscope and auxiliary device for attaching the auxiliary device to the endoscope such that the auxiliary device moves in coordination with the endoscope.

17. - The method according to claim 16, further characterized in that the at least one fixation device keeps the fixation device in a radial position substantially fixed in relation to the endoscope, but that allows the axial sliding of the auxiliary device in relationship with the endoscope.

18. - The method according to claim 16, further characterized in that a plurality of radially expandable fixation devices are arranged radially around the endoscope and the auxiliary device at a plurality of locations along a length of the endoscope and the auxiliary device .

19. - The method according to claim 16, further characterized in that the fixation device has a coiled configuration which is positioned around the endoscope and the auxiliary device by rotating the fixation device around the endoscope and the auxiliary device.

20. - The method according to claim 16, further characterized in that the fixation device includes a plurality of ring-shaped segments each having first and second terminal ends, and wherein the fixation device is positioned around the endoscope and the auxiliary device by separating the terminal ends of each segment to expand the fixation device, and positioning the expanded fixation device around the endoscope and the auxiliary device, whereby the terminal ends of each segment are brought together to couple the endoscope and the auxiliary device.

21. The method according to claim 16, further characterized in that the fixing device includes a groove formed on an internal surface thereof and adapted to accept the auxiliary device therein to maintain the auxiliary device in a radially fixed position in relationship with the endoscope.